We Need A New Job Title

Okay, I apologize for the run-on sentences and what can be construed as a rant, but bear with me.

Having the title of certified registered nurse anesthetist is a mixed bag. Don’t get me wrong. I’m proud to be a CRNA, and I’m proud that my background is in nursing. However, the one part of my day that always causes some level of consternation is introducing myself to my patients.

“Hi. My name is such and such. I am a nurse anesthetist and will be providing your anesthesia today.”

What’s wrong with that? Absolutely nothing.. but you know what I often hear afterwards?

“Thanks doctor.”

Or

The patient is on the phone and about to hang up, “Hold on. I’ll call you back. My nurse doctor is here.”

Or

“What medical school did you go to?”

I swear, nurse anesthetists have a terrible job title and probably the worst PR campaign promoting its profession because it’s been over 150 years and to this day, I’ve yet to come across a patient who truly understands what I actually do. 99% of patients I’ve come across can’t even say anesthetist!

“Anesthet….Anesthesss….uh, nurse anesthesiologist…”

Seriously, if an individual can’t even enunciate a word, how do you really expect them to conceptualize what you do? Why am I writing about this topic? It’s because to this day, I have yet to come up with a one size fits all answer. I find myself feeling neurotic about this very question. Do I attempt to educate and inform the patient and their family about what I do and what my qualifications are and risk sounding like I have an inferiority complex?

“No sir, I am not an anesthesiologist. I’m a certified registered nurse anesthetist. I completed a 2 year graduate level program in anesthesia and I worked in an ICU setting for x amount of years. My training is in nursing.“

Do I avoid answering the question altogether?

“I’ll be providing your anesthesia today.”

I risk sounding and even feeling like I have an inferiority complex when I try to take the time to explain why I’m a qualified anesthesia provider; or worse, I risk misrepresenting myself to my patients, which for the record, I do not do, but I will tell you working in both an academic and private practice setting causes me to experience a whirlwind of emotions over such a trivial interaction. Let me clarify what I mean by trivial because the pre-operative is NOT a trivial interaction. I’m just referring to that moment when I walk to the patient’s bedside, smile, extend my hand and introduce myself. It should just be that. A simple introduction, but it’s probably one of the weirdest interactions I’ll have with a patient because when the words “nurse anesthetist” comes out of my mouth, there’s a look of confusion that comes over the patient and their family’s face.

In an academic setting, it’s even more confusing because sometimes the anesthesiologists that I work with will introduce the both of us as the anesthesiologists, which is clearly untrue. So, what do I do there? Correct this individual in front of the patient or wait until this person leaves to reveal to the patient that I’m actually a nurse. Regardless, it just looks strange and makes one wonder, why spend more energy on this topic than one needs to? Let’s just dive into the preop exam and move on. But should we???

In private practice, I’m less likely to encounter such questions even though the way I introduce myself in that world is no different than how I introduce in an academic setting. However, I have a sneaking suspicion as to why I don’t encounter these questions as much. (1) I’m male; (2) I wear glasses because apparently all doctors wear glasses. I’m just kidding about the second point. It’s a shame that that unconscious bias still persists in our world, but even after introducing myself a CRNA, it’s been my experience that all of my patients end up calling me doctor by the end of the interview.

What’s even worse is when the surgical team calls you doctor even though you’ve introduced yourself a CRNA. I can’t tell you how many times I’ve encountered this. When I first started as a CRNA, I would go out of my way to correct everyone because it was important to me to let everyone know what my actual role was. As I previously said, the profession needs to improve its PR campaign to educate the public. At the time, I felt like I needed to do that.

I have to admit though, that over time, it just slowly grinds you down. It’s been my experience that no one around cares. And when I do correct individuals, I either get an apathetic response and even worse, “well, you might as well be a doctor, so I’m going to keep saying doctor.” Yes, this has happened to me. An OR nurse once said that to me in front an attending anesthesiologist as we were emerging a patient.

Again, why does this matter? It probably doesn’t. I think the reason why it makes me so neurotic is because I care about what I do and I think it’s important that people understand what CRNAs do and how they’re an instrumental part of the perioperative team. I have nothing against anesthesiologists (well, only the ones that denigrate our contributions to healthcare), but it’s imperative CRNAs take credit for their work. It’s disappointing when one comes up against what feels like a constant tidal wave of unconscious bias that you’re an anesthesiologist from laypersons to professionals that you work with. It’s even more deflating when you personally attempt to push back and find that your efforts fall on deaf ears.

So, how do I respond to patients? It’s depends on the context. If a patient demonstrates an actual desire to learn the difference between a nurse anesthetist and anesthesiologist, I’ll take the time to discuss that difference, which is the optimal route because I get to promote the profession while someone actually cares to listen. Otherwise, if the patient doesn’t care (and why should they? Most people are nervous about having surgery anyways, so as long as there’s someone providing the anesthesia, I get the feeling that they really don’t have the time or energy to truly care), why spend 2-3 minutes explaining the subtle, but key differences between both professions? What’s unfortunate about that scenario is that it leaves one party unaware of what CRNAs actually do and it leaves me feeling like I didn’t do my part to promote and raise awareness about nurse anesthetists. Then again, you can’t force people to learn things that they don’t even know that they should care about.